The following article features coverage from the 2021 ASCO Quality Care Symposium. Click here to read more of Cancer Therapy Advisor’s conference coverage.

The financial burden of a cancer diagnosis is increasing for privately insured, nonelderly adults in the United States, according to a study presented at the 2021 American Society of Clinical Oncology (ASCO) Quality Care Symposium.

Mean out-of-pocket costs increased significantly over time for all 4 cancers studied — breast, lung, prostate, and colorectal cancer — even when overall treatment costs did not increase.

“The rising cost-sharing requirement from private insurance has exacerbated the financial burden for cancer patients,” said Ya-Chen T. Shih, PhD, of the University of Texas MD Anderson Cancer Center in Houston, who presented the findings at the meeting.

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For this study, Dr Shih and colleagues set out to estimate the total and out-of-pocket costs for cancer care around the first year of a cancer diagnosis (from 2 months prior to diagnosis through 12 months after diagnosis) in nonelderly adults with private insurance.

The researchers analyzed data from the Health Care Cost Institute, which encompasses individuals who have health insurance from 3 of the 5 largest insurers in the United States — Aetna, Humana, and United Healthcare.

The study cohort included adults diagnosed with the 4 most common cancers at ages 18 to 64 years. The cohort consisted of 105,255 patients with breast cancer, 59,197 with prostate cancer, 23,571 with colorectal cancer, and 11,321 with lung cancer.

Total and Out-of-Pocket Costs

From 2009 to 2016, the mean total costs of cancer care increased significantly for 3 of the 4 cancers. The annual growth rates (AGRs) were 3.7% for breast (P <.001), 1.5% for lung (P <.001), 0.6% for prostate (P =.006), and 0.2% for colorectal cancer (P =.089).

Over the same time period, there was a significant increase in out-of-pocket costs for all 4 cancer types. The AGRs were 2.7% for breast and prostate (P <.001 for both), 2.5% for lung (P =.002), and 2.0% for colorectal cancer (P <.001).

The increase in out-of-pocket costs was driven, in part, by increasing deductibles. For all 4 cancers, deductibles accounted for about 30% of out-of-pocket costs in 2009, but this rose to around 40% in 2016.

Costs by Treatment

From 2009 to 2016, the mean costs of systemic therapy decreased significantly for colorectal cancer and increased for the other 3 cancers. The AGRs were 5.0% for breast and prostate (P <.001 for both), 1.9% for lung (P =.008), and -5.3% for colorectal cancer (P <.001).

Dr Shih said the decrease in systemic therapy costs for colorectal cancer occurred because generic versions of oxaliplatin entered the market during the period studied.

Similarly, the mean costs of radiation decreased for 1 cancer but increased for the other 3. The AGRs were 3.2% for colorectal (P <.001), 2.9% for lung (P <.001), 0.8% for breast (P <.001), and -1.3% for prostate cancer (P <.001).

The decrease in radiation costs for prostate cancer was the result of a policy change that reduced the reimbursement rate for intensity-modulated radiation therapy, Dr Shih explained.

The mean cost of surgery increased for all 4 cancers, but the increase was not significant for lung cancer. The AGRs were 3.9% for breast, 3.0% for prostate, and 2.3% for colorectal cancer (P <.001 for all) but 1.3% for lung cancer (P =.181).

Disclosures: Two study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Read more of Cancer Therapy Advisor’s coverage of ASCO QCS 2021 by visiting the conference page.


Shih Y-CT, Xu Y, Bradley C, et al. Trends in total and out-of-pocket cost of cancer care around the first year of diagnosis for the four most common cancers among privately insured nonelderly adults: 2009-2016. J Clin Oncol. 2021;39:(suppl 28; abstr 5). doi:10.1200/JCO.2020.39.28_suppl.005

This article originally appeared on Cancer Therapy Advisor